AccountId: 011433970860
ContactId: bb88c28d-75b5-4ba6-88e0-6d526032cc98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313720 ms
Total Talk Time (AGENT): 143294 ms
Total Talk Time (CUSTOMER): 93080 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/bb88c28d-75b5-4ba6-88e0-6d526032cc98_20250108T21:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling to verify benefits for one of our patients, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Uh, can you please give me your callback number just in case the call gets dropped?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is the patient's name, please?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. I, oh, let me spell it. It's [PII] Last name is [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you spelling her name out for me. I was wondering how [PII] was spelled. I thank you for that. Um, what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, and then what is her policy number?
[CUSTOMER][NEUTRAL] I have for outpatient benefit certificate number is 02559281 M as in Mary, L as in Larry I'm sorry 8 number 8 it's it's almost [PII] here. Time to go.
[AGENT][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am. Yes.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Alright, so I'm gonna pull in the policy for us real quick.
[AGENT][POSITIVE] And I'll give you those benefits and eligibility also um.
[AGENT][NEUTRAL] The insured does have an active policy and her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay or co-insurance, and she has an outpatient benefit amount of $500 and that $500 is per occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so it's her website?
[AGENT][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] Per occurrence. OK.
[CUSTOMER][NEUTRAL] So for every data service she has $500 available?
[AGENT][NEUTRAL] Right, per occurrence, so she has to pay a deductible, co-pay or co-insurance, that $500 helps per occurrence for that day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, for that date, OK. And does that cover, it does, it does it matter if it's a type of service, let's say if it's for office visits, or, or is that strictly for diagnostic services?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me um pull in her policy and let me read it and see if she has office visits.
[AGENT][NEUTRAL] And it's gonna be just a second while the computer pulls it in it's a pretty large policy.
[AGENT][NEUTRAL] OK, let me look at the scheduling.
[AGENT][NEUTRAL] I'm sorry, you're having to hold, but it's, it's a pretty big policy, so I'm having to find the office visits. OK, so yes, um, it does cover physician's office. Uh, it says the location in which the physician routinely on an appointment basis provides health examinations, diagnosis and treatment of sickness or injury due to an accident.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] On an ambulatory basis.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Excellent. OK, can I have a call reference number please?
[AGENT][NEUTRAL] Yes ma'am, you can use my name's [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh one more last thing, does she have a maximum, an out of pocket maximum?
[AGENT][NEUTRAL] Mm, let me look and see if she has any maximums at all.
[AGENT][NEGATIVE] No, she does not.
[CUSTOMER][POSITIVE] OK. Excellent. Thank you so much, [PII]. Have a great day and happy [PII].
[AGENT][POSITIVE] You too. You have a wonderful day too, and thank you so much for calling [PII] and [PII], I hope your [PII] is awesome.
[CUSTOMER][NEUTRAL] Is that one
[CUSTOMER][NEUTRAL] Likewise bye bye.
[AGENT][NEUTRAL] Bye bye.